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FAQs About the Affordable Care Act Implementation, Part XIV (Concerning the Required Summary of Benefits and Coverage)Seven Q&As about SBCs, including: "[1] What templates should plans and issuers use for the SBCs and the uniform glossary required to be provided after the first year of applicability? ... [2] Our plan is already working on the process of preparing SBCs for issuance in the second year of applicability and it would be an administrative burden to add the new data element to the template at this point in the process. Is any relief available to provide information about MEC and MV without changing the SBC template? ... [5] Safe harbors and other enforcement relief were provided by the Departments related to the requirement to provide an SBC and a uniform glossary for the first year of applicability. Will this relief be extended?"
(Departments of Labor, Health and Human Services, and the Treasury)

Supreme Court Declares That Plan Terms Trump Equity (PDF)"McCutchen is a win for plan sponsors, but the Supreme Court assigned plan sponsors homework: ensure that plan recovery rights are clearly stated and that equitable defenses are clearly disclaimed.... ERISA plan documents govern in all respects, from determining eligibility and benefits, to the terms for resolving litigation when participants and employers disagree.... McCutchen may provide a solid basis for limiting litigation cost through plan provisions that trump common law or equitable principles."
(Paul Hastings LLP)

ACI is pleased to present its 2nd National Advanced Compliance and Benchmarking Forum on Minimizing Legal Risks in the Design, Implementation & Administration of EMPLOYEE BENEFIT PLANS. Discount code BEN200 for BenefitsLink readers.

[Guidance Overview]

Proposed Rule on the ACA's 90-Day Waiting Period Provides Flexibility for Multiemployer Plans"In order to implement the rule, [multiemployer] plan sponsors should ... [1] Review the eligibility requirements for each of the fund's plan options. [2] For funds that measure work based on hours worked (rather than earnings), determine the length of the eligibility period and the lag period. If the lag period exceeds 90 calendar days and/or the eligibility period plus the lag period exceeds 13 months, review options for revising the eligibility and/or lag periods, and the potential impact on fund operations and costs."
(Segal)

Employer Health Premiums Rose 170% in California Over Last Decade"Premiums for employer health insurance in California jumped 170% over the last decade, more than five times the 32% increase in the state's inflation rate. That escalation in premiums has taken a toll on employers' willingness to offer health benefits ... 60% of California firms offered health benefits last year, down from 73% three years ago."
(Los Angeles Times)

Senate Committee Gives Go-Ahead for Tavenner Appointment as CMS Administrator"With a Senate committee vote in her favor Tuesday morning, Marilyn Tavenner moved a step closer to becoming the first confirmed administrator that [CMS] has had in 7 years.... 'She has been an effective leader during her tenure as the acting administrator for CMS ...,' AMA President Jeremy Lazarus, MD, said ... '[D]uring this important time for the Medicare and Medicaid programs it is important to have a strong, well-qualified leader who is able to build consensus.'"
(MedPage Today)

The FMLA, 20 Years Later (PDF)"[I]n hindsight, some of the concerns voiced by the FMLA's opponents were warranted. The act imposes significant burdens on employers. The regulations are highly technical, leaving little room for employer error when it comes to things like the timing and content of required notices. At the same time, the regulations lack meaningful answers to many critical questions ... By all appearances, the DOL is impervious to these burdens[.]"
(Morgan Lewis via New Jersey Law Journal)

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Reinstate Fun, Family Focus to Recruit and Retain"As employees continue to feel more confident about changing jobs, employers once again are turning to nontraditional and sometimes unique job perks to help them meet their hiring needs and retain star staff members. A new wrinkle with this recovery: These aren't across-the-board, extra benefits to which everyone is entitled. More companies are customizing perks to suit the specific employees they have targeted for retention. Some hold out special benefits as rewards for a job well done."
(Business Management Daily; free registration required)

Medicare Part D Roulette: Potential Implications of Random Assignment and Plan Restrictions (PDF)"Dual-eligible (Medicare/Medicaid) beneficiaries are randomly assigned to a benchmark plan, which provides prescription drug coverage under the Part D benefit without consideration of their prescription drug profile.... Auto-assigned beneficiaries had only a 34% chance of being assigned to the lowest cost plan; the remainder faced potentially significant avoidable out-of-pocket costs."
(Centers for Medicare & Medicaid Services)

Characteristics of the Population With Consumer-Driven and High-Deductible Health Plans, 2005-2012 (PDF)"[T]he population of adults within both high-deductible (HDHP) and traditional health plans [has] been split 50-50 between men and women.... [D]ifferences in gender have been found between consumer-driven health plan (CDHP) enrollees and those with traditional coverage. In most years, CDHP enrollees were less likely than those with traditional coverage to be between the ages of 21 and 34, and the CDHP population was more likely than traditional-plan enrollees to be in households with $150,000 or more in income in every year except 2009 and 2010."
(EBRI)

Governments May Push Employees Out of Employer Plans and Into Health Exchanges"Washington state lawmakers have found a creative way to pass a large chunk of their health care expenses along to Washington, D.C.... The plan ... would push a group of employees out of their current health care plans and into an [ACA] exchange ... Observers say the shift seems to run counter to the intent of the new health care law. Supporters, however, say it's a viable strategy for governments to pursue as they manage the insurance rules related to part-time staff.... [I]t's unclear whether the federal government accounted for this possible outcome."
(AP via Washington Post)

'Accountable Care' Helping Hospitals Keep Medical Costs Down"On a stormy evening this spring, nurses at [a Chicago doctor's] family practice were on the phone with patients with heart ailments, asking them not to shovel snow. The idea was to keep them out of the hospital, and that effort -- combined with dozens more like it -- is starting to make a difference: across the city, doctors are providing less, but not worse, health care.... This approach is one small part of a growing effort by providers to hold down costs without restricting needed care."
(The New York Times)

Under ACA Program, Doctor Visits Would Become Data Points"A new nonprofit is putting millions of Obamacare dollars towards an effort to turn routine doctor visits into a treasure trove of data on what medical treatments work best.... PCORI announced ... how it would move forward on that mission: spend $68 million to fund a network of health-care systems that cover as many as 12 million patients."
(The Washington Post)

What's the Future for Employer-Provided Benefits?"Factors behind the soaring cost of care include 'paying providers for doing more rather than for being more efficient,' a wave of consolidation among hospitals that has enabled them to charge higher prices, the longstanding tax breaks for providing health insurance and the relatively low prices charged to patients for seeking care and the fact that 'we're getting older, fatter and sicker' ... [The ACA] will bring more people into health plans, but with only finite resources to pay for their care, the result will be 'more cost-shifting and risk-shifting onto employees'[.]"
(Human Resource Executive Online)

The Salad Bar That Turned Around a Fortune 500 Company"In this CDC study, reducing the price of salads drove up consumption by 300%. If this was a stock, we would all rush out to buy it.... [E]mployers looking for an answer to a persistent medical care spending conundrum would be wise to start looking at their environments and the messages that they are sending employees, either overtly or subtly."
(The Health Care Blog)

Racing to Inform Millions Unaware of New Health Coverage"[I]n Michigan, a small army of doctors and nurses, hospital employees, insurance agents and advocates for low-income people is mobilizing for the next phase of this revolution in domestic social policy: finding people who are eligible for health insurance and getting them enrolled. It will not be an easy task."
(The New York Times)

Summary of Oral Argument in Supreme Court Dispute About Federal Employee's Life Insurance Beneficiary"[T]he issue reduced to whether [the beneficiary order of precedence stated in the Federal Employee's Group Life Insurance Act] is solely designed for the administrative convenience of federal plan administrators (in which case the state law likely would not be preempted), or instead reflects a more robust congressional agenda to ensure that the insured's choice of beneficiary would be honored so that designated beneficiaries not only receive, but also keep, life insurance proceeds (in which case the state law almost certainly would be preempted). Because the statute does not accomplish either purpose perfectly, the advocates faced the challenge of trying to square a circle to the Justices' satisfaction -- and the Justices were not easily satisfied."
(SCOTUSblog)

Trends in Hospital-Based Childbirth Care: The Role of Health Insurance"US hospital-based births covered by private insurance were associated with higher rates of obstetric intervention than births paid for by Medicaid. After controlling for clinical, demographic, and hospital factors, cesarean delivery rates increased more rapidly among births covered by private insurance, compared with Medicaid. Changes in insurance coverage associated with healthcare reform may impact costs and quality of care for women giving birth in US hospitals."
(American Journal of Managed Care)

Employers Embracing Tech to Distribute Summaries of Benefits and Coverage"86% of survey respondents used electronic distribution to send SBCs to their employees.... [A]bout half of the employers reported they had to produce more than 10 separate SBCs. More than 25% of employers reported they were required to produce between 25 and 100 separate SBCs, and six percent produced more than 100 versions.... About 41% said they were also distributing paper copies while only 14% relied exclusively on hardcopy printing and distribution."
(HighRoads)

Losing Employer Coverage Undermines Health Care Law"The nonpartisan Congressional Budget Office forecast that 7 million Americans will lose or drop their employer-provided health insurance by 2022.... That's not a future we should welcome. The employer-based system has reliably and effectively delivered quality health coverage to generations of Americans. As a nation, we need to work to preserve it."
(Janet Trautwein, CEO, National Association of Health Underwriters, via nwi.com)

[Opinion]

Think Obama's Medicare Savings Aren't Significant? Take a Closer Look"Some of the budget's Medicare changes -- including all of its changes affecting beneficiaries -- phase in slowly and secure the bulk of their savings after the first ten years, when we will need them most because budget deficits are projected to then start widening again.... Are the slow phase-ins of the budget's changes affecting Medicare beneficiaries a problem? Quite the contrary, they are likely to be essential to ensuring that the changes are both politically acceptable and sustainable."
(Center on Budget and Policy Priorities)

[Opinion]

Structuring Legal, Ethical and Practical Workplace Health Incentives"[W]orkplace health promotion programs have the potential to significantly improve population health by leveraging the workplace as a setting for health improvement and risk reduction. After all, approximately 155 million people go to work each workday and spend most of their waking hours there. Contrast that to the very limited time spent with a medical provider, which may total 1-2 hours a year for most of us."
(Health Affairs)

[Opinion]

Is the Slowdown in Health Care Spending Good News?"What is clear though is that much of the slowing not related to the economy has been due to the imposition of greater cost sharing, especially higher deductibles, and to the ratcheting up of managed care intrusions such as more restrictive provider lists and greater use of tiering of benefits. For containing costs, these are unwise policies because they create barriers that impair access to health-care services that patients should have. That is a terrible way to control spending."
(Physicians for a National Health Program)

[Opinion]

Testimony before Department of Treasury on ACA Employer 'Shared Responsibility' Provisions (PDF)"First and foremost, ERIC encourages the agencies to clarify the methodologies available to employers for counting an employee's hours of service. It is absolutely essential ... that employers be permitted to use one methodology to count hours for those who are clearly either full-time or part-time employees on the date of hire, and to use a different methodology (such as the lookback safe harbor) to count hours for so-called variable hour employees."
(The ERISA Industry Committee)

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